1306005624 NPI number — DR. JENNIFER L GLEN DNP

Table of content: DR. JENNIFER L GLEN DNP (NPI 1306005624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306005624 NPI number — DR. JENNIFER L GLEN DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLEN
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHALSKI
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306005624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2265 S. NINTH ST
Provider Second Line Business Mailing Address:
DBA SALINA REGIONAL URGENT CARE
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-452-6000
Provider Business Mailing Address Fax Number:
785-452-6591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2265 S. NINTH ST
Provider Second Line Business Practice Location Address:
DBA SALINA REGIONAL URGENT CARE
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-452-6000
Provider Business Practice Location Address Fax Number:
785-452-6591
Provider Enumeration Date:
06/02/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  2005033658 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2005033658 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 5375694 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 1499928 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 068002336 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 201119710A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".